shu-508 and Carcinoma--Ductal--Breast

The aim of this study was to evaluate the accuracy of contrast-enhanced color Doppler ultrasound (CE-US) in comparison with contrast-enhanced MR imaging (CE-MRI) in the discrimination of hypervascularized breast tumors. An additional CE-US of the breast was preoperatively performed in 40 patients with a hypervascular breast lesion detected on CE-MRI. The presence of blood flow signals and the morphological characteristics of the vessels in the breast lesions were evaluated pre- and post-contrast administration, as well as the dynamic aspects of the Doppler signal, including time interval to maximum signal enhancement and persistence of the signal enhancement. Twenty-three carcinomas and 17 fibroadenomas were explored. Considering initial signal enhancement > 100% after the administration of contrast material as a criterion suggesting malignancy, CE-MRI showed a sensitivity of 100% and a specificity of 76.5% in the detection of malignant breast tumors. Color Doppler signals were consistently demonstrated in all carcinomas and in 68.7% of fibroadenomas after the administration of Levovist, with CE-US showing a sensitivity of 95.6% and a specificity of 5.9%. Neither the mean number of vessels per tumor, nor the location of vessels, the time to maximum increase of the Doppler signal or the persistence of signal enhancement showed significant differences between benign and malignant lesions. Additional CE-US does not increase the low specificity of MRI in patients with hypervascularized breast tumors.

Topics: Adult; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Contrast Media; Diagnosis, Differential; Female; Fibroadenoma; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Predictive Value of Tests; Ultrasonography, Doppler, Color

We investigated improving the evaluation of benignity in breast lesions using Doppler sonography with galactose palmitic acid-coated microbubbles.. In 77 patients with 84 breast tumors scheduled for surgical tumor removal, color-coded duplex sonography was performed before and after administration of Levovist. Of the 77 patients, 25 with 28 lesions had been treated for prior breast carcinoma. The parameters investigated were the following: degree of enhancement, number of tumor vessels, time to maximum enhancement, and the pattern of vascular morphology and course.. Findings in malignant tumors (n = 53) showed a greater number of vessels and a faster stronger enhancement after Levovist administration, whereas a definite partial overlap with results from benign tumors (n = 31) was found. The best distinction was produced by vascular morphology and course, with a sensitivity of 90% and a specificity of 81 %. In 23 of the 25 patients who previously underwent surgery, a clear distinction was possible between a postoperative scar (n = 11) and a tumor recurrence (n = 17).. Although administration of the contrast agent clearly improved evaluation of benign features on Doppler sonography, absolute certainty cannot be achieved. The feasibility of making an otherwise difficult distinction between a scar and tumor recurrence on sonography and mammography appears to be promising, but further studies are necessary.

Topics: Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Contrast Media; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary

Findings in previous investigations have indicated that contrast-enhanced colour Doppler can be used to improve the demonstration of characteristic features of neovascularization in malignancies. However, the quantification of the increase in colour Doppler signals after Levovist in the cited study relied only on descriptive criteria defined by the investigator, resulting in a subjective scoring system. A computer-assisted method for quantitative analysis of colour pixel density is a novel approach for objective assessment of colour Doppler signal after contrast media administration. After microbubble contrast medium injection in 47 patients, carcinomas and benign lesions behaved differently regarding degree, onset and duration of Doppler enhancement. However, the high interindividual variability and the temporal variations of the Doppler signal still limit the value of these criteria for prospective diagnosis. Rapid image-acquisition techniques are needed in order to apply the necessary mathematical processing before the contrast kinetics can be used for diagnostic purposes.

Topics: Adult; Aged; Blood Flow Velocity; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Contrast Media; Diagnosis, Computer-Assisted; Female; Fibroadenoma; Fibrocystic Breast Disease; Humans; Image Processing, Computer-Assisted; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary

To evaluate objectively the effects of a microbubble contrast agent on the color Doppler ultrasound (US) examination of breast lesions.. Forty-seven patients aged 23-71 years underwent color Doppler US before and after intravenous injection of a microbubble contrast agent. A 3-minute computer-assisted assessment of the color pixel density (CPD) was used to evaluate objectively the increase in the number of color Doppler US signals, the transit time of the microbubble bolus, and the potential additional differential diagnostic information.. Peak CPD at contrast agent-enhanced color Doppler US was 14.3% +/- 8.1 (mean +/- 1 standard deviation) for carcinomas and 9.3% +/- 4.9 for benign lesions (P = .04). The time to peak enhancement was shorter in carcinomas (38 seconds +/- 20) than in benign tumors (71 seconds +/- 48, P = .02). Final CPD was close or equal to baseline values. With the median of 13% for peak CPD as a threshold, the sensitivity for this parameter was 55%, the specificity was 79%, and the accuracy was 62% (P = .04). For a median time to peak of 50 seconds, the sensitivity was 84%, the specificity was 57%, and the accuracy was 76%.. After microbubble contrast agent injection, carcinomas and benign lesions behave differently in degree, onset, and duration of Doppler US enhancement. High interindividual variability and temporal variations in the Doppler US signal still limit the value of these criteria for prospective diagnosis.

Topics: Adult; Aged; Blood Flow Velocity; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Contrast Media; Female; Fibroadenoma; Fibrocystic Breast Disease; Humans; Image Processing, Computer-Assisted; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color